title: Subutilization of COPD guidelines in primary care: a pilot study.
abstract: CONCLUSIONS
  Despite the popularity of chronic obstructive pulmonary disease (COPD) guidelines, studies have reported important deficits among primary care physicians (PCPs) with respect to diagnosis and treatment of COPD; as a consequence, COPD remains underrecognized and undertreated.
  
  
  METHODS
  This was a multicenter pilot study to assess prescribing practices for COPD by PCPs according to COPD guidelines. This was a 2-phase study: In phase 1, PCPs from 27 Mexican cities, referred patients for evaluation, including spirometry and in phase 2, PCPs from 10 of those same cities were asked to answer a questionnaire on COPD practice guidelines.
  
  
  RESULTS
  A total of 2293 subjects were included in phase 1; 472 (20.6%) had a FEV1/FVC <70%. Only 39% of patients with 30% ≤ FEV1 < 50% and 22% with FEV1 <30% were receiving combination therapy (long-acting bronchodilator + inhaled steroid). In phase 2, we recruited 999 PCPs; 72.5% of them said that they had read a COPD guideline and 59.4% answered that they used one in their practice. When asked which guideline(s) they used, we had 86 different responses with GOLD (Global Initiative for Chronic Obstructive Lung Disease; 34.1%) being the most common, followed by GINA (Global Initiative for Asthma; 12.8%). When asked why they did not used a guideline, we got 33 different answers; "never read them" was the most frequent answer (41.8%) followed by "lack of access to them" (18.2%) and "not enough time to read them" (6.0%).
  
  
  CONCLUSIONS
  Despite the existence and availability of evidence-based guidelines, only a minority of primary health care COPD patients in Mexico are receiving state-of-the-art treatment at the primary care level.
authors.affiliation: Universidad Autónoma de Baja California, Tijuana, Mexico. rlaniado@uabc.edu.mx
authors.forename: Rafael
authors.initials: R
authors.lastname: Laniado-Laborín
authors.forename: Adrian
authors.initials: A
authors.lastname: Rendón
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Alcantar-Schramm
authors.forename: Rebeca
authors.initials: R
authors.lastname: Cazares-Adame
authors.forename: Otto
authors.initials: O
authors.lastname: Bauerle
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008800:Mexico; D058007:Physicians, Primary Care / Q000592:standards* / Q000706:statistics & numerical data; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D013147:Spirometry; D011795:Surveys and Questionnaires
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents
keywords: chronic obstructive pulmonary disease (COPD); continuous medical education; guidelines; prescription practices; primary care